Colorectal Cancer is the second most common form of cancer in the United States and the third most common form in the Veterans Affairs medical system. It has the second highest mortality rate nationally, with an estimated 56,300 deaths in 2000. Colorectal cancer mortality can be reduced by early detection, and screening procedures have been widely recommended by professional groups. Despite these recommendations, screening has not been widely adopted by patients and physicians. The Health Belief Model was developed to explain the widespread failure of people to engage in disease prevention or to undergo screening tests for the early detection of asymptomatic disease. This project uses the Health Belief Model as a theoretical framework to develop a physician- and patient-directed intervention to increase colorectal cancer screening rates in the Veterans Affairs population. The patient educational portion of the intervention takes into account the racial/ethnic diversity and broad range of literacy levels of the patient population, and draws on successful projects targeting breast and prostate cancer screening for persons with low literacy skills and low socioeconomic status. The physician-directed portion of the intervention builds on a previously developed continuous quality improvement (CQI) program that formed the basis of a recently completed VA randomized trial for primary care physicians. The project's specific aims are to: 1) assess patient and physician factors that affect the use of colorectal screening with fecal occult blood testing (FOBT) and flexible sigmoidoscopy in the primary care setting, and 2) develop and evaluate the effectiveness of a combined intervention targeting patients and physicians that is designed to improve rates of colorectal cancer screening tests in general medicine clinics in the Veterans Affairs Chicago Health Care System-Lakeside Division. The proposed interventions will improve the standard Veterans Affairs colorectal cancer screening protocol and will provide a model for methods and materials to increase screening rates in other settings.